Study highlights Medicare overspending on undelivered, unnecessary treatments

Nursing homes across the country are overcharging the Medicare system about $1.5 billion annually, according a federal study released this week.

According to Wall Street Journal, the report from the Dept. of Health and Human Services found that one out of every four bills received from nursing homes to the Medicare system are filled with overcharges for services that were either not performed or deemed unnecessary. Nursing homes “upcode” the services they provide patients covered by Medicare because they’re confident they’ll receive a full reimbursement from it.

In many instances, the upgraded or more intensive care was never performed, it was merely tacked on to a patient’s bill when it was sent to the government for payment. In others, the care billed to Medicare for patients was deemed unnecessary and would provide no clinical benefits to them. These services included scheduling speech therapy or occupational therapy sessions, according to the report. In a single example highlighted by the source, a patient under hospice care had refused a specific treatment but Medicare was billed by the nursing home anyway.

It’s that kind of wanton disregard for the system and the fact those overseeing the distribution of Medicare payments will not spot any errors that’s racked up more than $32.2 billion in Medicare spending already this year at the 15,000 nursing homes across the country that accept Medicare patients. The HHS report delivered this week by Inspector General Daniel R. Levinson estimated that at least $1.5 billion of that spending is on services that weren’t performed or necessary.

Medicare spending may be the single largest drain on the national budget. As it stands, at least 13.5 percent of all federal spending is dedicated to Medicare and the national healthcare program has become a political tool for the two major parties to dangle before voters. President Barack Obama, the report notes, claims to have already cut about $3.7 billion in fraudulent Medicare spending annually.

Services are likely to be cut in the coming year as Congress and the President seek ways to avoid the so-called fiscal cliff.

Some experts interviewed by indicate that as much as 30 percent of all government spending on healthcare is wasteful, be it on services that aren’t necessary or aren’t performed or on pharmaceuticals that either aren’t delivered or prescribed unnecessarily.

The HHS report suggests the federal government do more to track claims on Medicare services and review the process that determines what therapy methods are best in order to cut at least this portion of the wasteful spending.

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